FORMULARY - Rood & Riddle Veterinary · PDF fileThe Rood and Riddle Equine Hospital Formulary of Medications in Usecontains medications and ... (loading dose), then Respiratory

FORMULARYOF MEDICATIONS IN USE

and

LABORATORYMANUAL

The Official Equine Hospital & Veterinary Partner

of the

ROOD & RIDDLE EQUINE HOSPITALP.O. BOX 12070

LEXINGTON, KY 40580

859-233-0371www.roodandriddle.com

ROOD & RIDDLE VETERINARY PHARMACYP.O. BOX 12150

LEXINGTON, KY 40581

859-246-0112Fax 859-246-1760

www.roodandriddlevetpharm.com

ROOD & RIDDLE VETERINARY LABORATORY2150 GEORGETOWN RD.

LEXINGTON, KY 40511

859-233-0371email: [email protected]

© ROOD & RIDDLE EQUINE HOSPITAL 2007

DISCLAIMER

ROOD & RIDDLE EQUINE HOSPITAL MAKES NO REPRESENTATIONS OR WARRANTIES, AND DISCLAIMSALL WARRANTIES, EXPRESS OR IMPLIED, CONCERNING THE CONTENTS OR USE OF THE FORMULARY ANDLABORATORY MANUAL. WITHOUT LIMITING THE GENERALITY OF THE FOREGOING, ROOD & RIDDLEEQUINE HOSPITAL HEREBY DISCLAIMS ANY IMPLIED WARRANTIES WITH RESPECT TO THE FORMULARY ANDLABORATORY MANUAL, INCLUDING WITHOUT LIMITATION ANY IMPLIED WARRANTIES OF MERCHANTABIL-ITY, FITNESS FOR A PURPOSE, AESTHETICS, OR NON-INFRINGEMENT.

FURTHER, ROOD & RIDDLE EQUINE HOSPITAL MAKES NO WARRANTY CONCERNING THE ACCURA-CY OF THE INFORMATION CONTAINED IN THE FORMULARY AND LABORATORY MANUAL. THE USE OFINFORMATION FROM THE FORMULARY AND LABORATORY MANUAL IS THE SOLE RESPONSIBILITY OF THEPRACTITIONER DIRECTING THE CARE OF THE PATIENT.

IN NO EVENT SHALL ROOD & RIDDLE EQUINE HOSPITAL HAVE LIABILITY OF ANY KIND INCLUDINGANY SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, EXEMPLARY OR PUNITIVE LOSSES OR DAMAGES,EVEN IF ROOD & RIDDLE EQUINE HOSPITAL KNEW OR SHOULD HAVE KNOWN OF THE POSSIBILITY OF SUCHPOTENTIAL LOSSES OR DAMAGES RESULTING FROM INFORMATION CONTAINED IN OR USE OF THE FORMU-LARY AND LABORATORY MANUAL.

ROOD & RIDDLE EQUINE HOSPITALFORMULARY OF MEDICATIONS IN USE

The Rood and Riddle Equine Hospital Formulary of Medications in Use contains medications anddosages in use in our practice. This guide is intended as an aide to practitioners, but should not be viewedas a recommendation for the use of any medication, nor should it be viewed as a complete or comprehensivelisting of all uses, indications, or adverse effects. Please note that the use of many medications is extra-labelor off-label. Drugs are listed by generic names, followed by the trade name in some cases.

The following people contributed to the formulary:

Bryan Waldridge, D.V.M.Lori Bidwell, D.V.M.

Claire Latimer, D.V.M.Michelle LeBlanc, D.V.M.

Pete Sheerin, D.V.M.Steve Reed, D.V.M.Tom Riddle, D.V.M.

TABLE OF CONTENTS

FORMULARY page 1General Formulary page 1Ophthalmology page 7Anesthesia page 11Theriogenology page 13

LABORATORY MANUAL page 15Available tests page 16Normal Values page 19References page 24Referral Laboratories page 25

1

Acepromazine (10 mg/ml) 0.044-0.66 mg/kg, IV or IM Sedation, vasodilation, promote lactationAcetazolamide 2 mg/kg, PO, q8-12h Treatment and prevention of HYPP attacksAcetylcysteine 8g with 20g NaHCO3 in 200 ml water Retention enema for meconium impaction Albuterol 360-720 µg, q3-12h, via Aeromask*or Equinehaler* Bronchodilator; give 15 minutes before inhaled steroids

*Available from MilburnAltrenogest (2.2 mg/ml) 0.044-0.088 mg/kg, PO, q24h Maintain pregnancy; suppress estrusAmikacin (250 mg/ml) 25 mg/kg, IV, q24h Gram negative aerobes predominantly,

some Gram positives Aminocaproic acid (250 mg/ml) 20 g in 1 L IV fluids bolus, Inhibits fibrinolysis, stabilizes blood clots;

then 10 g, IV, in fluids q6h hemoabdomenAmpicillin sodium foals: 20 (11-30) mg/kg, IV or IM, q6-8h Gram positive aerobes, some anaerobes

adults: 10-50 mg/kg, IV or IM, q6-8h and Gram negativesAspirin 10-100 mg/kg, PO, q24h Antithrombotic, anti-platelet effectsAtropine (15 mg/ml) 0.02 mg/kg, IV, once Rescue bronchodilation for heaves; observe for colicAzithromycin 10 mg/kg, PO, q24h R. equi, Gram positives and some Gram

(after 5 doses, can be given q48h) negative aerobesBeclomethasone 500-3500 µg, q12h, via Aeromask*or Equinehaler* Heaves, inflammatory airway disease

*Available from MilburnBethanechol 0.3-0.4 mg/kg, PO, q6-8h Increase gastric emptying and bladder contractility

0.025-0.1 mg/kg, SC, q6-8hBismuth subsalicylate foals: 2-4 oz, PO, q6-8h GI protectant, antidiarrheal. anti-prostaglandin effects;

adults: 0.5 gal/454 kg, PO, q4-6h weak antibacterialN-butylscopolammonium 0.3 mg/kg, IV Antispasmodic; colic and rectal relaxation bromide [Buscopan] (20 mg/ml) during palpationButorphanol (10 mg/ml) 0.01-0.02 mg/kg, IV Analgesic, sedative

0.2 mg/kg/hr, IV, CRI Can be administered with lidocaine CRICaffeine 10 mg/kg, PO (loading dose), then Respiratory stimulant

2.5-3.0 mg/kg, PO, q12hCarbamazepine 4-8 mg/kg, PO, q6-8h Photic headshaking, may be combined with

cyproheptadineCefazolin foals: 11-20 mg/kg, IV, q8- 12h Gram positives, most anaerobes except Bacteroides fragilis;

variable to poor activity against Gram negatives

MEDICATION DOSAGE INDICATIONS

GENERAL FORMULARY

Ceftazadime [Fortaz] (200 mg/ml) 25-50 mg/kg, IV, q6-12h Gram positives and negatives, most P. aeruginosaCeftiofur [Naxcel] (50 mg/ml) label: 2.2-4.4 mg/kg, IM, q24h Gram positives and negatives

foals: 2.2-5.0 mg/kg, IM or IV, q12-24hCeftriaxone [Rocephin] (100 mg/ml) 20-50 mg/kg, IV or IM, q12h Gram positives and negatives, some anaerobes;

meningitisChloramphenicol 50 mg/kg, PO, q6h Human health risk (aplastic anemia) Gram positives

20-50 mg/kg, IV, q4-8h and negatives, many anaerobes, Lawsonia intracellularisCimetidine (150 mg/ml) 12-20 mg/kg, PO, q8h; 18 mg/kg, PO, q12h H2 blocker, reduces gastric acid production

6.6 mg/kg, IV, q4-6h; 4 mg/kg, IV, q12h Faster onset of action than proton pump inhibitors2.5 mg/kg, PO, q8h Melanoma immunotherapy (suppresses suppressor T cells)

Clarithromycin 7.5 mg/kg, PO, q12h R. equi, Gram positives and some Gram negative aerobes

Clenbuterol (72.5 µg/ml) 0.8-3.2 µg/kg, PO, q12h Bronchodilator, promotes sweating, possible tocolytic Cyproheptadine 0.2-0.6 mg/kg, PO, q12h Photic headshaking (monotherapy)

0.2-0.5 mg/kg, PO, q 12-24h Administered with carbamazepine for photic headshakers0.6-1.2 mg/kg, PO, q24h Pituitary pars intermedia dysfunction; appetite stimulant

Detomidine (10 mg/ml) 0.01-0.04 mg/kg, IV or IM α2 agonist sedative, analgesicDexamethasone 0.05-0.2 mg/kg, IV, IM, or PO, q12-24h Dexamethasone suppression test- 0.04 mg/kg, IM,

at 5:00 PM, post dexamethasone sample 19 hours laterDiazepam (5 mg/ml) 0.05-0.4 mg/kg, IV Anticonvulsant or sedationDimethyl sulfoxide (DMSO) 90% 0.1-1.0 g/kg, IV or via NG tube, q12-24h Hemolytic if given at greater than a 10% solutionDiphenhydramine 1 mg/kg, IV or IM Antihistamine, fluphenazine toxicityDomperidone 1.1 mg/kg, PO, q24h Dopamine antagonist, tall fescue toxicity agalactiaDopamine 2-5 µg/kg/min, IV, CRI Increase perfusion, urine production, blood pressure Doxapram (20 mg/ml) 0.5 mg/kg, IV Respiratory stimulantDoxycycline 10 mg/kg, PO, q12h Variable Gram positive and negative spectrum, some

anaerobes, Lawsonia intracelluarisEnrofloxacin 7.5 mg/kg, PO, q24h; 4 mg/kg, PO, q12h Gram negative aerobes, variable Gram positive spectrum,

poor activity against Streptococci; possible arthropathy 5.5 mg/kg, IV, q24h in foals

Epinephrine (1 mg/ml or 1:1000) 0.01-0.02 mg/kg, IV 4.5-9 ml/450 kg; 0.5-1.0 ml/50 kgErythromycin lactobionate 2.2 mg/kg, IV, CRI over 30-60 mins, q6h ProkineticErythromycin phosphate 37.5 mg/kg, PO, q12h R. equi, L. intracellularis, Gram positives, some

Gram negatives

MEDICATION DOSAGE INDICATIONS2

Fenbendazole 5 mg/kg, PO Dewormer- pinworms, large and small strongyles10 mg/kg, PO, q24h, for 5 days Larvicidal encysted L3 small strongyles; some

antiulcer effectsFluconazole 14 mg/kg, PO (loading dose), then Plasma and body fluid concentrations above

5 mg/kg, PO, q24h MIC for most equine fungal pathogensFlunixin meglumine (50 mg/ml) 1.1 mg/kg, IV or PO, q12-24h NSAID, analgesic

0.25 mg/kg, IV, q6-8h “anti-endotoxic dose” lowers possibility of GI or renal toxicity

Fluphenazine 0.05-0.08 mg/kg, IM Human anti-psychotic, severe extrapyramidal effects possible

Fluticasone 2000 µg, q12h, via Aeromask*or Equinehaler* Heaves; inflammatory airway disease*Available from Milburn

Furosemide (50 mg/ml) 0.5-2.0 mg/kg, IV or IM, q12-24h 250 mg, IV (pre-race, 4 hours before post, check state regulations)

Gentamicin (100 mg/ml) 6.6 mg/kg, IV or IM, q24h Predominantly Gram negative aerobes, some Gram positives

Glycopyrrolate (0.2 mg/ml) 0.007 mg/kg, IV Heaves, bronchodilation, less colic risk0.0022 mg/kg, IV, q8h Interstitial pneumonia, bronchodilation

Heparin (1000 U and 10,000 U/ml) 40 U/kg, IV or SC, q8h Monitor PCV- may cause anemia, agglutination of RBC66 U/kg, IV, q12h for 3 days Post operatively for adhesion prevention

Hetastarch 6% in 10 ml/kg, IV, prn Colloid fluid to treat shock; may interfere with 0.9% sodium chloride injection clotting function

4 ml/kg, IV Used in combination with plasma for hypoproteinemia (e.g. Lawsonia)

Hyaluronic acid [Legend] 40 mg/horse, IV; 20 mg/horse, IA, q7d Anti-inflammatory for synovitis; adhesion prevention (IV)Hydroxyzine 0.5-1.0 mg/kg, PO, q12h AntihistamineHypertonic saline (7%) 5 ml/kg, IV, rapid infusion Rapid blood volume expansion; follow with isotonic fluidsHypertonic saline (3%) 3-5 L/500kg to effect Head traumaImipenem 10 mg/kg, IV, q6-12h Multiple resistant infections; some Pseudomonas resistanceInterferon α 50-150 U, PO, q24h, for 5-10 days Inflammatory airway diseaseIodide (EDDI or KI) 1-2 mg/kg, PO, q12-24h, for one week, then Antifungal, antibacterial; observe for signs of iodinism;

0.5-1.0 mg/kg, PO, prn Dose same for organic or inorganic iodidesIsoxsuprine 0.66-1.32 mg/kg, PO, q12h Rheologic, variable bioavailability, high first-pass

hepatic uptake


3

Itraconazole 3 mg/kg, PO, q12h Antifungal; Aspergillus sp. Ketamine (100 mg/ml) 2.2 mg/kg [1.1 mg/lb], IV Dissociative anesthetic, sedate with xylazine pre-op

0.02 mg/kg/min, IV CRI(after loading dose) Hypoxic, ischemic encephalopathy, seizure controlKetoprofen (100 mg/ml) 2.2 mg/kg, IV, q12-24h NSAID, lower risk of toxicity compared to other NSAIDs Lidocaine 2% (20 mg/ml) 1.3 mg/kg loading dose, then 0.05 mg/kg/min, IV, CRI Prokinetic, give loading dose again if infusion is stopped

(450 ml in 3 l LRS at 500 ml/hr in a 500 kg horse)Magnesium sulfate 4-16 mg/kg, IV CRI, per 5 L bag Treatment for hypomagnesemia

2 mg/kg/min, IV bolus Ventricular tachycardia (up to a total dose of 50 mg/kg)50 mg/kg, IV CRI for 1 hour, then 25mg/kg/hr, IV, CRI Hypoxic-ischemic encephalopathy

Mannitol 20% (200 mg/ml) 0.25-2 g/kg, IV, q6h (over 30 minutes) CNS edemaMeclofenamic acid 2.2 mg/kg, PO, q12-24h Non-steroidal anti-inflammatory drugMethocarbamol (100 mg/ml) 25-75 mg/kg, PO, q12h Central acting muscle relaxant

5-55 mg/kg, IV slow, q6h Metronidazole (5 mg/ml) 15 mg/kg, IV, q6h Anaerobes, antiprotozoal, may have some GI

15-25 mg/kg, PO, q8-12h anti-inflammatory effects, can cause anorexia PO25 mg/kg, per rectum, q6-8h

Metoclopramide (5 mg/ml) 0.1-0.25 mg/kg/hr, IV, CRI Prokinetic- upper GI tractfoals: 0.02-0.1 mg/kg, IM or IV, q6-8h Can cause CNS excitement, colic

Misoprostol 2 µg/kg, PO, q8h Synthetic PGE1; right dorsal colitis, GI mucosal protectantMorphine 0.1 mg/kg, IV or IM, q4-6h May also give detomidine IM to avoid excitementNaloxone 8-10 mg/horse, IV Hemorrhagic shock, hemoabdomen

0.1 mg/kg, IV Hypoxic/ischemic encephalopathy (can be repeated prn)Naproxen 10 mg/kg, PO, q12-24h Non-steroidal anti-inflammatory drugOmeprazole 4 mg/kg, PO, q24h Treatment of gastric ulcers, proton pump inhibitor

1 mg/kg, PO, q24h Prevention of gastric ulcersOxytetracycline (200 mg/ml) 6.6-10 mg/kg, IV, q12-24h Variable Gram positive and negative spectrum,

some anaerobes10 mg/kg, IV, q24h Equine monocytic ehrlichiosis (PHF), L. intracellularis2-3 g/foal, IV in 1 l NaCl, q24h,for 1-3 days Flexural contracture in foals

Oxytocin (20 U/ml) 10-20 IU IV or IM every 4-12 hours Post breeding endometritis10-20 IU IV or IM every 4 hours Retained placenta, metritis20-60 IU in 1 L fluids IV (Administer slowly over 1 hour) Retained placenta0.11-0.22 U/kg, IV Choke- males or open mares only

Pentoxiphylline 8.5 mg/kg, PO, q12h Rheologic, anti-endotoxic, theoretically improves circulation


Pergolide 0.002-0.01 mg/kg, PO, q24h (1-5 mg/500kg) Pituitary pars intermedia dysfunctionPhenazopyridine 4-5 mg/kg, PO, q8-24h Urinary antispasmodic, anesthetic Phenobarbital foals: 5-25 mg/kg, IV Anticonvulsant

2-10 mg/kg, PO, q12h Maintenance therapy; increase dose 20% q2wk, prnPhenylbutazone (200 mg/ml) 4.4-8.8 mg/kg, IV or PO, q12-24h Anti-inflammatory, analgesicPhenylephrine (10 mg/ml) 3 µg/kg/min, IV, CRI over 15 mins Splenic contraction for nephrosplenic entrapment, jog afterPhysostigmine 0.06-0.08 mg/kg, IV, slowly Narcolepsy stimulation testPiroxicam 0.3 mg/kg or 80-100 mg/horse, PO, q24h Adjunctive therapy for transitional or squamous cell

carcinomaPolymyxin B 3,000-6,000 U/kg in 1 L fluids, IV, q8-12h Binds endotoxinPolysulfated glycosaminoglycan 500 mg, IM, q4d, for 28 days Articular anti-inflammatory, inhibits proteolysis [Adequan] 250 mg, IA, q7d, for 5 weeks and PG productionPonazuril 5 mg/kg, PO, q 24h for 28 days EPM, 10 mg/kg for first week achieves higher blood levels Potassium bromide 25 mg/kg, PO, q24h Anticonvulsant ± phenobarbital; increase dose

20% q2wk, prn; Requires 3-5 weeks to reach steady state

Potassium penicillin (500,000 U/ml) 22,000-44,000 U/kg, IV, q6h Gram positives and anaerobesPotassium chloride (2 mEq/ml) 20-40 mEq/l, IV, CRI in fluids Electrolyte supplement, promotes GI motility

0.1 g/kg, PO, prn (lite salt)Prednisolone 0.25-1.0 mg/kg, PO, q12-24h Anti-inflammatoryPrednisolone sodium succinate 0.25-2.5 mg/kg, IV, q6h-prn Shock, CNS trauma, anaphylaxis, interstitial pneumonia[Solu-Delta-Cortef] 30 mg/kg, IV, followed by 5 mg/kg as CRI for 8 hours Acute spinal cord traumaProcaine penicillin G (300,000U/ml) 22,000 U/kg, IM, q12h Gram positives and anaerobesPyrimethamine 1 mg/kg, PO, q24h Administer with sulfonamide for EPMRanitidine 6.6-7.5 mg/kg, PO,q8h; H2 blocker, reduces gastric acid production,

11.3mg/kg,PO,q12h Faster onset of action than proton pump inhibitors1.5 mg/kg, IV, q8h; 1.3 mg/kg, IV, q12h

Reserpine 2-5 mg/horse, PO, q24h Sedative effects, promotes lactation, can cause loose manure

Rifampin 5 mg/kg, PO, q12h R. equi, L. intracellularis, give with other antibiotics to prevent resistance

Selenium (with Vitamin E) [E-Se] 1 ml/100 lbs, IM White muscle disease; dysphagia in foals


5

Sodium bicarbonate (1 mEq/ml) isotonic: 150 mEq/ 1 L sterile water, IV, prn Replace 1/2 deficit after rehydrating, then recheck A/B status

50-150 g/day, up to q8h, PO (baking soda) 1 ml of baking soda ≈ 1 g ≈ 12 mEq HCO3-Sodium penicillin (500,000 U/ml) 22,000-44,000 U/kg, IV, q6h Gram positives and anaerobesSucralfate 1-2 g/100 lbs, PO, q6h Binds to ulcerated submucosa: gastric ulcers;

right dorsal colitisSulfadiazine 20 mg/kg, PO, q12-24h Administer with pyrimethamine for EPMThiamine 10 mg/kg, IV in fluids, q12-24h Hypoxic-ischemic encephalopathy, polioencephalomalaciaTicarcillin 50 mg/kg, IV or IM, q6-8h Gram positives, Pseudomonas sp., EnterobacteriaceaeTolazoline (100 mg/ml) 4 mg/kg, IV, slowly (1 ml/sec) Reversal α2 agonist sedation; higher receptor affinity

than yohimbineTrimethoprim/Sulfamethoxazole 15-30 mg/kg, PO, q12h Gram positive and Gram negative aerobes;

Streptococcal resistance fairly common21.3 mg/kg, IV, q24h Do not give with α2 agonists

Tripelennamine (20 mg/ml) 1.1 mg/kg, IM, q6-12h Antihistamine, must be given IM only (CNS excitement)Vancomycin (50 mg/ml) 6 mg/kg, IV, q8h Aerobic Gram positives, MRSA, C. difficileVitamin C 30-50 mg/kg, IV, q12h, in fluids Antioxidant (red maple toxicity)Vitamin E (Natural) 6000 U/horse, PO, q24h Antioxidant, CNS anti-inflammatory; EPM; motor neuron

disease; equine degenerative myeloencephalopathyXylazine (100 mg/ml) 0.5-1.1 mg/kg [0.25-0.55 mg/lb], IV α2 agonist sedative, analgesic; higher dose pre-op

with ketamine Yohimbine 0.075 mg/kg, IV slowly α2 antagonist; reversal of α2 agonist sedation


AKWA Tears Ointment and Solution PRN Tear replacement/augmentation.Alomide™ (lodoxamide tromethamine) Ophthalmic q6-12h; Tolerance may be Mast cell stabilizer. May relieve inflammation Solution 0.1% (1.78 mg lodoxamide tromethamine improved by mixing with associated with eosinophilic keratoconjunctivitis. equivalent to 1 mg lodoxamide) artificial tear solution May burn on instillation.Atropine Sulfate Ophthalmic Ointment 1%, q12h Uses and contraindications (10mg/gram of ointment) same as for Ophthalmic Solution.Atropine Sulfate Ophthalmic Solution 1%, (10mg/ml) q12h Mydriatic and cycloplegic.

Relieves ciliary body spasm due to 1° or 2° anterior uveitis. Can cause ileus and decrease tear production.

Chloramphenicol Ophthalmic Ointment 1%, q3-8h Broad spectrum, bacteriostatic antibiotic. (10mg/gram of ointment) Good ocular penetration. Pseudomonas usually resistant.

Often active against E. coli, Staph and Strep.Ciloxan™ (ciprofloxacin hydrochloride) Ophthalmic q3-4h Corneal ulcers. Ointment 0.3%, (3.33 mg/gram of ointment, Broad spectrum, bactericidal agent equivalent to 3 mg base) used following culture and sensitivity.Ciprofloxacin hydrochloride Ophthalmic Solution 0.3% q2-4h Used through subpalpebral lavage system.(3.5 mg equivalent to 3 mg/ml) Indications as for ointment.Crolom™ (cromolyn sodium) q8-12h. Often mixed with Inhibits degranulation of mast cells. No intrinsic Ophthalmic Solution 4%, (40mg/ml) artificial tear solution or gel antihistamine or anti-inflammatory activity.

May relieve symptoms of eosinophilic keratoconjunctivitis.

Dexamethasone Ophthalmic Ointment 0.1% q6-12h Uveitis. Contraindicated in corneal ulceration (compounded) and/or infection. May cause corneal degeneration.Diclofenac Ophthalmic Ointment 0.1% (compounded) q8-12h NSAID for non infectious keratitis and uveitis.Erythromycin Ophthalmic Ointment 0.5%, q4-8h Treatment of conjunctival or corneal bacterial (5mg/gram of ointment) infections. Bacteriostatic. May be bactericidal

at higher concentrations.Flurbiprofen Sodium Ophthalmic Solution 0.03%, q8-12h NSAID for non-infectious keratitis (0.3 mg/ml) or uveitis.Gentamicin Sulfate Ophthalmic Ointment, q3-8h Bactericidal. (3mg/gram of ointment) Treatment of ocular bacterial infections.

Often good for Pseudomonas.


OPHTHALMOLOGY FORMULARY

7

Gentamicin Sulfate Ophthalmic Solution 0.3%, q2-6h Treatment of sensitive bacterial infections 3mg/ml via subpalpebral lavage systemItraconazole 1.0% / DMSO 30% Ophthalmic Ointment q4-6h Antifungal. DMSO may have additional (compounded) anti-inflammatory and antimicrobial properties.Lid Paint – Contains Dexamethasone (2mg/ml) q12-24h on skin overlying Topical application. Lacrimal gland adenitis associated and DOMOSO Solution in equal volumes lacrimal gland with eosinophilic keratoconjunctivitis.Miconazole Ophthalmic Ointment 2% (compounded) q4-6h Antifungal. Miconazole Ophthalmic Solution 1% (compounded) q3-4h Antifungal via subpalpebral lavage system.Mucomyst™ 20% (acetylcysteine) 20% solution q2-4h diluted to 5% Anti-collagenase via lavage for malacic ulcers.Mydriacyl™ (tropicamide) Ophthalmic Solution 1% Single application Short duration parasympatholytic to induce mydriasis (10mg/ml) for intraocular examination.Natacyn™ (natamycin) Ophthalmic Solution 5% q2-6h Fungal keratitis.(50mg/ml)Neobacimyx - H™ Ophthalmic Ointment (400 units q8-12h Acute bacterial conjunctivitis.bacitracin zinc, 3.5mg neomycin base, 10,000 units Contraindications: polymixin B sulfate, and 10 mg hydrocortisone acetate Corneal ulcers; fungal or viral infections.per gram)Neobacimyx™ Ophthalmic Ointment q3-q6h Good combination of bactericidal drugs (400 units bacitracin zinc, 3.5mg neomycin base, useful for initial treatment of infection.and 10,000 units polymixin B sulfate per gram)Neo-Poly-Bac Ophthalmic Ointment q3-q6h Same as Neobacimyx™. NeoPolyDex Ophthalmic Ointment (3.5mg neomycin q8-12h Bacterial conjunctivitis. base, and 10,000 units polymixin B sulfate, Decreases edema and inflammation and 1mg dexamethasone per gram) Contraindications: Corneal ulcers;

Viral, bacterial, or fungal disease.NeoPolyDex Ophthalmic Solution q8-12h Decreases edema and inflammation (3.5mg neomycin base, and 10,000 after nasolacrimal duct flush. units polymixin B sulfate, and 1 mg Contraindications: Corneal ulcers; Dexamethasone per ml) Viral, bacterial, or fungal disease.Optimmune™ (cyclosporine) Ophthalmic Ointment q8-12h Local immunomodulator. Management of 0.2% (2mg/gram of ointment) keratoconjunctivitis sicca and chronic superficial

keratitis. Safety in face of fungal or viral infections is unknown.


Phenylephrine Hydrochloride Ophthalmic Solution, Used pre-operatively Ophthalmic decongestant, vasoconstrictor, 25mg/ml (KEEP REFRIGERATED) and mydriatic. Pred Forte ™ (prednisolone acetate) q6-12h Glucocorticoid. Anti-inflammatory for treatment of Ophthalmic Solution 1% steroid responsive inflammation of the conjunctiva,

cornea and anterior segment of the globe. Contraindication: infection.

Proparacaine Hydrochloride Ophthalmic Solution 5%, Single application Topical anesthesia to facilitate ophthalmic exam. (5mg/ml) (KEEP REFRIGERATED) May be mixed with fluorescein stain prior to instillation.Sodium Chloride Ophthalmic Ointment 5% q6-8h Decreases corneal epithelial edema and (50mg NaCl/gm) supports healing when stromal bullae are present.Tacrolimus Ophthalmic Ointment 0.3% q8-12h Immunomodulator used like cyclosporine. (compounded) May have some benefit for uveitis.Tears Again™ (carboxymethyl cellulose sodium) PRN Tear replacement/augmentation.gel 1% or 1.5%Terramycin™ Ophthalmic Ointment (oxytetracycline q4-8h Broad spectrum antibiotic combination HCl equivalent to 5mg for bacterial conjunctivitis or keratitis.oxytetracycline and 10,000 units polymyxin B sulfate per gram)Timolol Maleate Ophthalmic Solution 0.5%, (6.8 mg q8-12h Treatment of elevated intraocular pressure; beta blocker.timolol maleate or 5mg timolol per ml)Tobradex™ Ophthalmic Ointment and Ophthalmic q8h Bacterial conjunctivitis resistant to less expensive Solution (Tobramycin 0.3% and Dexamethasone 0.1%) alternatives. Contraindication: bacterial infection

with resistant organisms, viral and fungal infections.

Tobramycin Ophthalmic Solution 0.3% (3mg/ml) q2-6h Same as Ophthalmic Ointment.Tobrex™ (tobramycin) Ophthalmic Ointment 0.3%, q3-8h Treatment of bacterial infection (3mg/gm) following culture and sensitivity.Trifluridine Ophthalmic Solution 1%, (10mg/ml) q2h initially tapering to QID Treatment of primary keratoconjunctivitis and (KEEP REFRIGERATED) recurrent epithelial keratitis d/t presumed

viral infection. Ointment (compounded) is preferred due to increased contact time.

Trusopt™ (dorzolamide hydrochloride) Ophthalmic q8-12h Treatment of elevated intraocular pressure. Solution 2%, (22.3mg/ml dorzolamide hydrochloride Warning: This is a Sulfonamide, therefore can have or 20mg dorzolamide per ml) similar reactions. Often combined with Timolol.


9

Vfend™ (voriconazole) 10mg/ml q2-6h topically Via subpalpebral lavage and intracameral (reconstituted injectable solution) Single dose intracameral for fungal keratitis. Voltaren™ (diclofenac sodium) q8-12h NSAID for non-infectious keratitis and uveitis.Ophthalmic Solution 0.1% (1mg/ml) Compounded ointment is available.


EMERGENCY DRUGS: Atropine 0.02mg/kg IV (0.01mg/lb) Anticholinergic - for bradycardia.Calcium gluconate 500ml in 5L LRS or drip to effect Positive inotrope.Dobutamine 5ml dobutamine (12.5mg/ml) in 250ml NaCl or Positive inotrope,

3ml in 150ml NaCl or LRS. Use a microdrip set: chronotrope at high doses.1 drop per 3-4 seconds for foals, 1 drop every other second for adults (dose is 1-5ug/kg/min)

Ephedrine 12.5mg to 25mg IV (0.25ml to 0.5ml) Causes the release of norepinephrine.dose is 0.03-0.07mg/kg IV

Epinephrine (1mg/ml) Foals: 0.5 - 1ml initially, if no response, then Cardiac arrest.every 3 - 5 minutes; Adults: 1 - 3ml initially, can give up to 10ml in large horses, repeat every 3 - 5 minutes if no response

Glycopyrrolate 0.005 mg/kg IV (0.0025 mg/lb) Anticholinergic.HCO3

- Isotonic solution 1mEq/kg IV, give over 20 minutes then re-evaluate Metabolic acidosis.(150 mEq/1 L sterile water) HCO3 levels (8.4% sodium bicarbonate has 1mEq/ml) Adequate lung function required.

mEq to correct deficit =(wgt. in kg x 0.3 x base excess for adults); (wgt. in kg x 0.4 x base excess for foals)

Heparinized Saline 0.125-0.25ml of 10,000 IU/ml heparin combined Catheter flush.with 250ml Saline (0.9%)

Lidocaine (20mg/ml) (0.5 - 1 mg/lb) ~250lb foal: 125 - 250mg = 6 - 12 ml Ventricular fibrillation/ventricular premature ~1000lb horse: 500 - 1000 mg = 25 - 50 ml contractions.

PAIN MANAGEMENT:Amantadine 2.2 - 2.4mg/kg PO q12 - 24h Anti-viral agent, used for chronic pain, anxiety.Amitriptiline 25 - 75mg once daily PO q8 - 12h Look for toxicity signs similar to use of an anticholinergic

(dilated pupils, decreased GI activity, etc.).Butorphanol 0.1 - 0.2 mg/kg/hr CRI Analgesic, sedative.Fentanyl 2 ug/kg loading dose followed by 5-10 ug/kg/hr Concurrent use of butorphanol can antagonize fentanyl

IV CRI at mu receptors. Gabapentin 2.5mg/kg PO BID; Can be increased to a Anti-epileptic medication,

maximum dose of 10mg/kg BID used for chronic pain.Hydromorphone CRI bolus 0.02 mg/kg then CRI 0.02 mg/kg/hr Analgesia - orthopedic/laminitis.


ANESTHESIA & PAIN MANAGEMENT FORMULARY

11

Hydromorphone/lidocaine Syringe pump 10ml 2% lidocaine and 1.5ml hydromor- Analgesia - orthopedic/laminitis.phone; Administer 1ml/hr for each 30 lb body weight

Ketamine 2-10 ug/kg/min CRI Analgesia - neuropathic/orthopedic/laminitis.Lidocaine 1.0 mg/kg bolus followed by CRI Analgesia; GI motility.

at 0.004 - 0.1 mg/kg/min in conjunction with other pain relief techniques

Lidocaine + Ketamine 1 gram lidocaine (50ml) + 1 gram ketamine (10ml) Analgesia - neuropathic/orthopedic/laminitis.(drip to effect)

Lidocaine CRI 1 gram lidocaine (50ml) in 1liter NaCl or LRS Analgesia - soft tissue, colics, orthopedic, neuropathic.(drip to effect)

Methadone 0.1 - 0.2mg/kg PO BID Mu and MNDA receptor activity.Morphine/Lidocaine/Ketamine 60mg morphine + 60mg ketamine + 500mg lidocaine Analgesia - neuropathic/orthopedic/laminitis.

in 500ml saline or LRS. Administer at 0.5 ml/kg/hr CRIMorphine 0.1mg/kg IV or IM, q8-12h For mild sedation; to avoid excitement administer

with α2 agonist. 0.16mg/kg loading dose, then 0.1mg/kg/h IV

Morphine intra-articular 0.1mg/kg Orthopedic analgesia.Morphine/Ketamine 60mg morphine + 60mg ketamine in 500 ml saline Analgesia - orthopedic/laminitis.

or LRS. Administer at 0.5 ml/kg/hr CRIPropofol 0.05-0.1 mg/kg/min CRI Analgesia - patient on ventilator or seizuring.Tramadol 2 - 5mg/kg PO BID Cross between an opioid and NSAID.PRE-ANESTHETICS:Acepromazine 0.02 - 0.04mg/kg IV (0.01-0.02mg/lb) Sedation, anti-anxiety.Butorphanol 0.02 - 0.1mg/kg IV (0.01-0.05mg/lb) Short duration analgesia.Detomidine 0.002-0.01mg/kg IV (0.001-0.005mg/lb), Pre-anesthetic for excited horses.

0.01-0.02mg/lb IMDiazepam 1-1.1mg/kg IV (0.04mg/lb) combined with ketamine Pre-anesthetic for foals.

for induction Muscle relaxant for induction combined with Ketamine.Xylazine 1mg/kg IV for pre-op (0.4mg/lb) Pre-anesthetic.

DRUG INDUCTION:Ketamine 2-2.2mg/kg IV for induction after sedation Short-acting general anesthetic.

with Xylazine or DiazepamTriple Drip (GKX) 500mg xylazine + 1g ketamine + 1L 5% guiafenesin. Total intravenous anesthetic.

Give as a bolus to effect


Altrenogest [Regumate®] 0.044mg/kg PO q24h Estrus suppression/Maintain pregnancy.0.088mg/kg PO q24h Placentitis/Pregnancy maintenance during stress.

Cloprostenol [Estrumate] (250ug/ml) 125 - 250ug IM Lysis of CL.Uterine contraction/Cervical relaxation.

Deslorelin (1mg/ml) 1-1.5mg IM Induces ovulation.Estradiol 17B, (3.33mg/ml) 10mg IM Used in ovariectomized or anestrus mares to induce

signs of estrus; relatively quick onset, short duration, repeated as needed.

Estradiol Cypionate [ECP] (2mg/ml) 4mg IM Used in ovariectomized or anestrus mares to induce signs of estrus; slower onset, longer duration, repeated as needed.

Follicle Stimulating Hormone 6.5mg IM BID Induces follicular development (anestrus); [eFSH] Follicles > 25mm.

12.5 mg IM BID Superovulation; Begin 4 - 5 d after ovulation when follicles > 25mm. Stop when follicles reach 35mm.

Gonadotropin Releasing Hormone 500 micrograms IM BID Follicular development.(250 micrograms/ml) Human Chorionic Gonadotropin 1500 - 3000 IU IV or IM Induces ovulation.Imipramine (50mg tablets) 1 - 2mg/kg PO 2 hours before semen collection Decreases ejaculatory threshold.Long Acting Progesterone 1500mg IM q7d Estrus suppression/Maintain pregnancy.(150mg/ml) Long Acting Progesterone / 1500/50mg IM q7d Estrus suppression/Estrus synchronization/ Estradiol (LA P&E) (150mg/5mg/ml) Maintain pregnancy.Misoprostol PGE Massage small amount on and into cervix Cervical relaxation(2000 micrograms/tube) 2 - 4 hours before breedingOxytocin 10-20 IU IV or IM every 4 hrs Post breeding endometritis.

10-20 IU IV or IM every 4 hrs Retained placenta, metritis.20-60 IU in 1 L fluids IV Retained placenta.(Administer slowly over 1 hour)

Progesterone (100mg/ml) 150mg to 300mg IM Estrus suppression/Maintain pregnancy..Progesterone / Estradiol [P&E] 150mg/10mg IM (3ml) Estrus suppression/Estrus synchronization/ (50 mg/3.3mg/ml) Maintain pregnancy.


THERIOGENOLOGY FORMULARY

13

Prostaglandin F2α [Lutalyse] 7.5 - 10mg IM Lysis of CL.(5mg/ml)Sulpiride 400mg IM SID for 10-16d Enhance follicular development.

INTRA-UTERINE TREATMENTS:DMSO (90%) 50ml DMSO /L (900mg/ml = 4.5% solution) Decrease mucus.

followed by 1 liter saline or LRS onlyTitratable iodine 1.0% 15cc Povidone Solution/L (1.5% solution) Disinfectant.[Povidone Solution] followed by 1 liter saline or LRS onlyVinegar (white vinegar) 100 ml vinegar/L Saline; Lavage until fluid clears Yeast infections.Mannose Add 500ml sterile water to 25 g; Infuse 100 ml Streptococcus or E. coli endometritis.

into uterus, wait 30 minutes, then lavage with saline/LRSAdd 333ml sterile water to 25 g (75mg/ml) solution); Pseudomonas endometritis.Infuse 100ml into uterus, wait 30 minutes, then lavage with saline/LRS

INTRA-UTERINE ANTIBIOTICS (qs to 60 ml with saline or sterile water)Amikacin (250mg/ml) 2g, Buffer with 35ml of 8.4% BicarbAmpicillin (250mg/ml) 2gCeftiofur (Naxcel) 1-2 gGentamicin (100mg/ml) 2g, Buffer with 35ml of 8.4% BicarbPolymyxin B (500,000 U/vial) 1,000,000 unitsPotassium Penicillin 10 million unitsTicarcillin and clavulanate [Timentin] 3.1-6.2g


VETERINARY LABORATORY MANUAL

ROOD & RIDDLE EQUINE HOSPITAL VETERINARY LABORATORY

2150 Georgetown RoadLexington, KY 40511

859-233-0371Fax 859-280-3489

[email protected]

The following people contributed to the Laboratory Manual:Bonnie Barr, V.M.D.

Marianne Swintosky, MTSteve Reed, D.V.M.Tom Riddle, D.V.M.

Renowned for their prompt turnaround of reliable test results, ROOD & RIDDLE EQUINE HOSPITAL VETERINARY LABORATORY

offers same day service for many of your laboratory needs (see individual tests for result time). In addition to fax and paper printouts, the Laboratory offers email of all results.

ROOD & RIDDLE EQUINE HOSPITAL VETERINARY LABORATORYaccepts specimens from local and out-of-state veterinarians.

Please call 859-233-0331 for information on mailing specimens.

PHYSICAL ADDRESS:2150 Georgetown Road Lexington, KY 40511

U.S. POSTAL SERVICE ADDRESS:P.O.Box 12070 Lexington, KY 40580

LEGENDRED Top – No additive

PURPLE Top – EDTAGREEN Top – Heparin

BLUE Top – Sodium citrateYELLOW Top – ACD

15

Hematology - same day resultsComplete CBC Purple and Red top Includes differential and fibrinogenCBC Pre-surgery Purple and Red top Includes a fibrinogenCBC Purple top No differential or fibrinogenFluid Analysis Purple top Includes WBC, RBC, TPCSF Analysis Purple and Red top Includes WBC, RBC, MTP

Chemistry - same day resultsBUN Red top or Green topCreatinine Red top or Green topSGOT/AST Red top or Green topT. Bili Red top or Green topD. Bili Red top or Green topALP/SAP Red top or Green topLDH Red top or Green topCPK/CK Red top or Green topSDH Red top or Green top For best results, keep cool and submit within 3 hoursGGT Red top or Green topAlbumin Red top or Green topCalcium Red top or Green topPhosphorous Red top or Green topGlucose Red top or Green topElectrolytes Red top or Green top Includes Na, K, Cl, HCO3Master Panel Red top or Green top Includes all the above chemistriesBasic Panel Red top or Green top All of the above chemistries excluding electrolytesFoal Profile Red top Includes BUN, Creatinine, and IgGBile Acids Red topLipase Red topAmylase Red topTriglycerides Red top Cholesterol Red topAmmonia Green top Keep on ice; submit sample within 30 min

VETERINARY LABORATORY – AVAILABLE TESTS

TEST SAMPLE REQUIRED COMMENTS

16

Chemistry - same day results (continued)Magnesium Red top or Green topIgG Red topBlood Gases Heparanized syringe Submit sample within 10 minMilk Electrolytes Sterile container Includes Na, K, Ionized and total calciumColostrum IgG Sterile containerImmunophoresis Red top Includes IgG, IgA, IgM, and IgG(t)

Coagulation - same day resultsPT Blue top PTT Blue top Platelet Count Blue top or Purple topClotting Profile Blue top Includes PT, and PTT

Hormone Assays - same day resultsProgesterone Red topTestosterone Red topT4 Red topTT3 Red topCortisol Red topInsulin Red top

NI Screening - results available in 1-3 daysBlood Type Yellow topAntibody Screen Red top Collect and submit sample 3 weeks prior to foaling

Immunohematology - same day resultsCoombs Purple topJaundice Foal Agglutination Colostrum in a sterile container and

foal’s blood in a Purple topTransfusion Crossmatch Purple top of donor and each recipient

TEST SAMPLE REQUIRED COMMENTS

17

SerologyAGID Coggins 24 hours* Red top Set up at 3PM and available the following day at 3PMELISA Coggins 2 hours* Red top Upon submission, notify lab technician*Online EIA results are also available via GlobalVetLink

Microbiology*****Results are not finalized until 72 hours after submission*****All samples with positive preliminary results are called to the doctor each morningCulture / Sensitivity Amies media, sterile container, or swab Label the sample with patient, Dr, siteSalmonella Specimen in sterile container or swab 48 hours before preliminary results ARD Culture Fluid sample in sterile container Antibiotic Removal DeviceAnaerobic Amies media, sterile container, or swabMycology/Fungal Amies media, sterile container, or swab Results may take 3-21 days

Cytology - same day resultsUterine cytology Pre-prepared slideFluid cytology Fluid sample in sterile container or EDTA Identify source

Fecal Testing - same day resultsRotavirus Fecal specimen in sterile containerClostridium difficile toxin Fecal specimen in sterile container Sample must be submitted before 2 pm each dayClostridium perfringens toxin Fecal specimen in sterile container Sample must be submitted before 2 pm each dayFecal Egg Count Fecal specimen in sterile containerFecal Occult Blood Fecal specimen in sterile containerCultures (See Microbiology)

Miscellaneous Testing - same day resultsAntibiotic Levels Red top Peak or trough for Amikacin and GentamicinUrinalysis Sterile container

TEST SAMPLE REQUIRED COMMENTS18

NORMAL LABORATORY VALUESPlease note that normal values include values from RREH laboratory standards, as well as normal values from reference papers (references are listed following the data and complete references are given at the end).

ADULT VALUES

UNITS RREH LAB THOROUGHBRED STANDARDBRED MINIATURE HORSE DRAFTHgB g/dl 11-14 10.9-18.8 11.3-17.9 9-16 8-14PCV % 30-42 29-53 31-48 23.7-42.7 24-42RBC 106/ ul 8-10 6.5-11.6 6.9-10.7 4.27-10.3 5.5-9.5MCV fl 39-49 40-49 38-60.5MCHC g/dl 337-386 350-410 327-397WBC 103/ ul 7,000-12,000 5,300-11,000 6,900-10,700 6,100-12,490 6,000-12,000SEG 103/ ul 3500-8400 (50-70 %) 1855-7480(35-68%) 2277-6741(33-63%) 1638-6745 (22-54%) 2100-9000 (35-75%)STAB 103/ ul 0-240 (0-2%) 0-220 (0-2%) 0-535 (0-5%) 0-375 (0-3%) 0-240 (0-2%)LYMPH 103/ ul 1400-4800 (20-40%) 1378-6270 (26-57%) 1932-5992 (28-56%) 3149-9617 (41-77%) 120-1200 (2-10%)MONO 103/ ul 0-360 (0-3%) 0-660 (0-6%) 0-535 (0-5%) 0-500 (0/4%) 120-1440 (2-12%)EOS 103/ ul 0-120 (0-1%) 0-800 (0-7%) 0-700 (0-6%) 0-874 (0-7%) 0-360 (0-3%)Bands 103/ ul rare 0-110 (0-1%) 0-214 (0-2%) 0-460 (0-4%) 0-222 (0-2%)TP g/dl 5.8-7.6 6.0-7.5 5.4-7.5 5.2-7.9 6.4-8.BUN mg/dl 8-26. 11-24 8-14 15.2-32.5 11.3-17.7CREAT mg/dl .08-2 .9-2.1 .9-1.7 0.7-1.4 1.4-2.0SGOT(AST) U/l 80-240 141-330 123-789 140-306 71.5-396.9FIB mg/dl 200-400 150-380T. BILI mg/dl .8-2 .9-2.6 .9-2.9 .7-1.7IND. BILI mg/dl .3-1.7 .6-2.5D. BILI mg/dl .2-1 .2-.8 .2-.7SAP U/l 50-150 26-92 24-67 81-304 55.7-127.1LDH U/l 52-240 81-225 74-206CPK (CK) U/l 50-250SDH U/l 0.8-4.2GGT U/l 6-24. 6-29ALBUMIN g/dl 2.4-5 2.9-3.6 2.7-3.4 3.1-4.1Ca mg/dl 9-12.5 10.7-12.4 10.9-12.9 10.16-12.56 10.8-13P mg/dl 3-6. 1.1-4.4 2.2-4.2 2.81-6.75 2.8-4.2GLU mg/dl 60-110 69-150 63-101 68-126 56.7-95.1Na mmol/l 136-144 134-142 137-143 132-140 131.9-142.3K mmol 3.6-5 2.1-4.2 29.-4.4 3.66-5.32 3.1-4.1Cl mmol/l 92-102 94-106 96-102 97.3-106.5HCO3 mmol/l 21-28 21.4-27.2Mg mEq/l 1.8-2.3 .53-.84

Lumsden, Rowe, Mullen 1980 Harvey, et al 1984 Gelser, et al 1984

19

FOAL VALUES

UNITS F<12HR F-1DY F-1WK F-1MO F-3MO F-6MO F-12MOHgB g/dl 12.6-17.4 12-16.6 10.7-15.8 10.9-15.3 11.7-15.3 10.8-15.4 11-15.4PCV % 37-49 32-46 28-43 29-41 32-42 29-41 31-42RBC x106/ ul 9-12 8.2-11 7.4-10.6 7.9-11.1 9.2-12 7.9-11.6 7.7-10.9MCV fl 36-45 36-46 35-44 33-40 31-38 32-39 35-44MCHC g/L 320-400 320-400 350-400 340-400 340-400 330-400 340-400WBC x103/ ul 6.9-14.4 4.9-11.7 6.3-13.6 5.3-12.2 6.7-16.8 7.8-11.6 6.5-11.8SEG x103/ ul 5.55-12.38 3.36-9.57 4.35-10.55 2.76-9.27 3.92-10.35 2.89-5.56 2.66-5.9LYMPH x103/ ul .46-2.54 .67-2.12 1.43-2.28 1.73-4.85 2.88-7.15 3.2-6.01 2.01-6.53MONO x103/ ul .04-.43 .07-.39 .03-.54 .05-.63 .12-.76 .04-.45 .04-.44EOS x103/ ul 0 0.-.02 0-.09 0-.12 0-.55 0-.55 0-.78BASO x103/ ul 0-.02 0-.03 0-.18 0-.08 0-.07 0-.06 0-.09TP(plasma) g/dl 5.1-7.6 5.2-8. 5.2-7.5 5.1-7.1 5.5-7.1 5.9-7.1 5.4-7BUN mg/dl 12.-27 9-40 4-20 6-21 7-20 15-30 15-24CREAT mg/dl 1.7-4.2 1.2-4.3 1-1.7 1.1-1.8 .7-2.2 1.2-2.1 1.3-2.1SGOT(AST) U/l 97-315 146-340 237-620 252-440 282-480 300-620 283-720FIB mg/dl 100-350 100-400 150-450 200-550 100-550 200-550 200-550T. BILI mg/dl .9-2.8 1.3-4.5 .8-3 .5-1.7 .4-2 .3-1.3 .4-1.4IND. BILI mg/dl .8-2.5 1.-3.8 .5-2.3 .4-1.2 .4-1.4 .1-.6 .2-.6D. BILI mg/dl .3-.6 .3-.7 .3-.7 .1-.6 .1-.7 .1-.7 .1-1SAP U/l 152-2835 861-2671 137-1169 210-866 206-458 155-226CPK (CK) U/l 65-380 40-909 52-143 81-585 57-204 97-396SDH U/l .2-4.8 .6-4.6 .8-8.2 1.2-5.9 1.1-3.9 .3-3.3GGT U/l 13-39 18-43 14-164 17-99 0-27 0-26ALBUMIN g/dl 2.7-3.9 2.5-3.6 2.7-3.4 2.7-3.4 2.8-3.5 3.-3.5 3.1-3.8Ca mg/dl 10.8-14.8 9.7-13.7 11.3-13.7 11-13.4 11.2-13.2 10.2-13.4 11.3-14.1P mg/dl 3.1-6.3 3.8-7.4 5.4-9.4 4.9-9.3 6.3-8.3 4.8-7.6 5.2-6.8GLU mg/dl 108-190 121-233 121-192 130-216 88-179 110-210 105-165Na mmol/l 133-163 123-159 130-154 136-154 140-156 133-153 134-158K mmol 3.4-5.4 3.6-5.6 3.8-5.8 3.8-5.4 3.4-5.8 2.8-5.6 2.2-5.4Cl mmol/l 93-117 93-117 94-110 97-109 102-110 98-112 99-109CO2 mEq/l 20-30 24-32 22-32 23-31 22-30 27-31Mg2+ mg/dl .7-2.3 .6-4.2 1.4-2.6 1-3 1.6-2.8 1.7-3.1Harvey et al (1984) and Bauer et al (1984)

20

Clotting TestsProthrombin time 8-13 secondsPTT 30-60 secondsPlatelet count 100,000-350,000 (Jain, 1986)***from RREH lab and Jain (1986)

UrinalysisColor pale yellow to brownViscosity viscous (mucoid)Transparency slightly turbidSpecific gravity 1.008-1.042 (foal 1.001-1.027)

Dipstick ChemistriespH 7.0-9.0 (acidic urine is normal in foals)protein none to possible trace glucose noneketones nonebilirubin noneblood none

Sediment Findings (microscopy)Casts rareRBC (hpf) 0-8WBC (hpf) 0-8Bacteria rareEpithelial cells/hpf rareCrystals moderate (primarily calcium carbonate,

occasional triple phosphate and calcium oxalate)***from Kohn and Chew (1987)

MISCELLANEOUS DIAGNOSTIC TESTS

TEST NORMAL VALUES

21

Peritoneal fluid analysisTotal nucleated cell count <10,000 /ulNeutrophils 24-62%Lymphocytes 0-35%Large mononuclear cells 5-60%Eosinophils 0-5%Basophils 0-1%Total protein <2.5 g/dl

Synovial fluid analysisTotal nucleated cell count <500/ulNeutrophils <10%Total protein 0.5-2.2 g/dlTotal red blood cells <1400/ulColor ClearViscosity High*** from Tew 1983

T3 0.5-6.0 ng/mlT4 9.0-36.0 ng/ml

Progesterone Pre-ovulation <0.5 ng/mlPost-ovulation >1.0 ng/mlSufficient to maintain pregnancy >3.0 - 4.0 ng/ml

Testosterone Stallion 40-210 ng/dlMares (nonpregnant) <50 pg/ml

Cortisol 1.9-9.2 ug/dl

Bile Acids <10 µmol/lGentamicin peak 32-40 ug/ml (30 minutes post drug administration) (with once a day dosing)

TEST NORMAL VALUES22

Amikacin peak 50-60 ug/ml (30 minutes post drug administration)(with once a day dosing)***from RREH labInsulin <5-20 uIU/ml ***Anderson 1997

Urinary fractional excretion of electrolytesFormula:Electrolyte Plasma (creat) Urine (Z) Fractional excretion = ------------------ X ------------- X 100

Urine (creat) Plasma (Z) Z= Na or K (each individual electrolyte)

Adults (%) Foals (%)Sodium 0-0.46 0.13-0.49Potassium 23.9-75.1 8.77-17.75Chloride 0.48-1.64 0.1-0.74Phosphorus 0.04-0.16Calcium 6.0-15.0Magnesium 7.8-22.5

****Kohn 1986 ***Brewer et al 1991

Blood gas values Arterial VenouspH 7.36-7.44 7.33-7.41PCO2 (mmHg) 34-49 46-64PO2 (mmHg) 73-115 ---HCO3 (mEq/L) 20-34 25-35Base excess (mmol/L) --- -1 to 7

***Aguilera-Tejero et al 1980 ***Soma et al 1996

Reference for converting conventional units to SI units:http://www.unc.edu/~rowlett/units/scales/clinical_data.html

http://www.globalrph.com/conv_si.htm

TEST NORMAL VALUES

23

Aguilera-Tejero E, Estepa JC, Lopez I, et al. “Arterial blood gases and acid-base balance in healthy young and aged horses.” Equine VetJournal 1998; 30(4):352-354.

Bauer JE, Asquith RL, Kivipelto J. “Serum biochemical indicators of liver function in neonatal foals.” Am J Vet Res 1989; 50(12): 2037-2041.

Bauer JE, Harvey JW, Asquith RL, et al. “Clinical chemistry reference values of foals during the first year of life.” Equine Vet. Journal1984; 16(4): 361-363.

Brewer BD, Clement SF, et al. “Renal Clearance, Urinary Excretion of Endogenous Substances, and Urinary Diagnostic Indices inHealthy Neonatal Foals.” Journal of Veterinary Internal Medicine 1991; 5 (1): 28-33.

Gelser DR, Goble DO, Held JP. “Normal Hematology and Serology of the Clydesdale Draft Horse”. Equine Practice 1984; 6(10): 7-11.

Harvey JW, Asquith RL, McNulty PK, et al. “Haematology of foals up to one year old.” Equine Vet Journal 1984; 16(4): 347-353.

Harvey RB, Hambright MB, Rowe LD. “Clinical biochemical and hematologic values of the American Miniature Horse: Reference values.” Am J Vet Res 1984;(5): 987-990.

Jain NC. “The horse: normal hematology with comments on response to disease.” In Schalm’s Veterinary Hematology, 4th edition,1986, Philadelphia, Lea & Febiger.

Kohn CW, Chew DJ. “Laboratory diagnosis and characterization of renal diseases in horses.” Vet Clinics North America Equine Pract.1987; 3:585-615.

Kohn CW, Strasser SL. “24-hour renal clearance and excretion of endogenous substances in the mare”. Am J Vet Res. 1986;47(6):1332-1337.

Lumsden JH, Rowe R, Mullen K. “Hematology and Biochemistry Reference Values for the Light Horse.” Can. J. Med 1980; 44(1): 32-42.

Nelson AW. “Analysis of equine peritoneal fluid.” Vet Clinics North America Large Animal Practice 1979; 1:267-274.

Ralston SL, Baile CA. “Plasma glucose and insulin concentrations and feeding behavior in ponies.” J Animal Sci 1982; 54(6): 1132-1137.

Soma LR, Uboh CE, Nann L, et al. “Prerace venous blood acid-base values in Standardbred horses.” Equine Vet Journal 1996;28(5):390-396.

Tew WP “Synovial fluid analysis: applications in equine joint injury and disease.” Proceedings of the 28th Annual Meeting of theAmerican Association of Equine Practitioners. 1983; 121-122.

REFERENCES FOR NORMAL LABORATORY VALUES24

Some laboratory tests are not performed at Rood & Riddle Veterinary Laboratory and should be sent directly to referral laboratories. A list of these tests and the name of the laboratory that performs each test for Rood & Riddle Equine Hospital is listed following the test. These tests and the names of laboratories are included to aid practitioners; please note that there are likely other laboratories performing these tests, and in some cases, you may be required to send specimens to a laboratory in your state.

Please call the laboratory before sending a specimen to: 1. Confirm the type of sample needed; 2. Give shipping instructions;3. Set up an account for billing.

ACTH IDEXX Purple top tubeBET Red top tube

Allergy testing Biomedical Red top tube Anaerobic culture UKLDDC Feces, aspirate, transtracheal wash fluid -

Sterile container with sealed lidBlastomycosis serology AGID UKLDDC Red top tubeBone Marrow Aspirate PENN Slide

Auburn SlideCardiac Troponin I New Bolton Center Green top tube (frozen)CEM culture UKLDDC Amies /charcoal tube (2 or 3 sites)CEM-CF test UKLDDC Red top tube Clostridium Perfringens PCR UKLDDC Culture plateCryptosporidia (acidfast) UKLDDC FecesDrug Tests Screens Cornell Green top tube (10 - 12 mls)D’xylose absorption series UC Davis Green top tubeEhrlichiosis (Erlichia equi) IFA OSU Red top tubeElectrophoresis UKLDDC Red top tube

Limestone Red top tubeEPM Profile I: (Western Blot) IDEXX Red top tube, cerebral spinal fluid

Western Blot (CSF) IDEXX Cerebral spinal fluidWestern Blot (serum) IDEXX Red top tube

Estrogen assay/Total Estrogens BET Red top tubeEVA titer UKLDDC Red top tube

Murray Red top tube

LABORATORY TESTS SENT TO REFERRAL LABORATORIES

TEST LAB SPECIMEN REQUIRED

25

Fluid Analysis HPA Aspirate, joint fluid, etc.Follicle Stimulating Hormone BET Red top tubeFungal culture UKLDDC Aspirate, transtracheal wash fluid, etc.Fungal sensitivity Cornell Fungal culture plateGranulosa Cell Tumor Panel UC Davis Red top tube (6 ml serum)Herpes 1 PCR UKLDDC Nasal swab and/or buffy coat (Purple top tube x4)Herpes 4 PCR UKLDDC Nasal swab and/or buffy coat (Purple top tube x4)Herpes titer (EHV serology)SN UKLDDC Red top tubeHistoplasmosis AGID UKKLDDC Red top tubeHYPP (hairs only) Vet Gen Tail or mane hairImmunophenotyping

of bone marrow aspirate KSU Slide of bone marrow (minimum 2 slides)of peripheral blood KSU Purple top tube

Influenza A Directigen test UKLDDC Nasal swabInfluenza I,2(HI) serum UKLDDC Red top tubeInhibin assay UC Davis Red top tube (6ml serum)Karyotyping Gluck 2 Green top heparinized tubes + 1 ACD tube

(keep cool do not freeze)Lawsonia intracellularis PCR UKLDDC Feces

titer UMINN Red top tubeLeptospirosis titer UKLDDC Red top tubeLeptospirosis UKLDDC UrineLethal White Overo Test Vet Gen Tail or mane hairs (25 - 30 hairs)Lyme Disease K-ELISA Murray Red top tube serum (1ml)

Western Blot w/K-ELISA Cornell Red top tube serum (2 ml) Muscle biopsy (tie-up) UMINN Muscle biopsy (call lab for specifics)Paratythroid MSU Red top tube serum (1ml)Piroplasmosis NVSL Red top tube serum (2ml)Platelet Surface Antibody KSU Purple top tube x4 (immunology)Potomac Horse Fever

PCR (Neorickettsia risticci) UKLDDC Purple top tubetiter / IFA UKLDDC Red top tube

Pregnant Mare Serum Gonadotropin BET Red top tubePrepurchase drug screen Cornell Green top tube (10ml)

TEST LAB SPECIMEN REQUIRED26

Reserpine Cornell Green top tube (10ml)Rotavirus Electron Microscopy UKLDDC Feces/iceSalmonella PCR IDEXX FecesSelenium level Cornell Purple top tube/iceStrep. equi PCR IDEXX Nasal/pharyngeal/guttural pouch wash

Titer IDEXX Red top tube (M-Protein)Testosterone BET Red top tubeVesticular Stomatitis UKLDDC Red top tube

Murray Red top tubeVirus isolation (Influenza & EHV) UKLDDC Tracheal wash fluid, pharyngeal lavage sample, nasal swabVitamin D MSU Red top tube on iceVitamin E Cornell Red top tube on ice

MSU Red top tube on iceWest Nile Virus IgM UKLDDC Red top tube

TEST LAB SPECIMEN REQUIRED

27

AUBURN - Auburn University, Department of Pathobiology, Clinical Pathology Laboratory, 166 Greene Hall, Auburn University, AL 36849 (334) 844-2653

BET- BET, Inc. - 1501 Bull Lea Road, Suite 102, Lexington, KY 40511 (859) 273-3036

BIOMEDICAL - Bio-Medical Services, P.O. Box 26600, Austin, TX (800) 444-2370

CORNELL - Cornell University, Animal Health Diagnostic Center, Upper Tower Road, Ithaca, NY 14853 (607) 253-3900

GLUCK - Gluck Equine Research Center, 1400 Nicholasville Road, Lexington, KY 40546 (859) 257-4757

IDEXX - Equine Biodiagnostics, 1501 Bull Lea Road, Suite 104, Lexington, KY 40511 (800) 621-8378

HPA - HPA Laboratories Inc., 10338 Stony Run Lane, Ashland, VA 23005 (800) 730-0095

KSU - Kansas State Veterinary Diagnostic Laboratory, 1800 Denison Avenue A-117, Manhattan, KS 66506 (785) 532-5650

LIMESTONE - Limestone Veterinary Laboratory, 1033 N. Limestone Street, Lexington, KY 40505 (859) 252-0415

MSU - Michigan State University, Diagnostic Center, 4125 Beaumont Road, Lansing, MI 48910 (517) 353-1683

MURRAY - Breathitt Veterinary Center, Murray State University, 715 North Drive, P.O. Box 2000, Hopkinsville, KY 42241 (270) 886-3959

NVSL - National Vet Services Laboratories, 1800 Dayton Avenue, Ames, IA 50010 (515) 663-7563

NEW BOLTON CENTER - University of Pennsylvania, 382 West Street Road, Kennett Square, PA 19348 (610) 444-5800

OSU - The Ohio State University, College Of Veterinary Medicine, 1925 Coffey Road, Columbus, OH 43210 (614) 688-4687

PENN - University of Pennsylvania, Clinical Pathology Laboratory, 3950 Delancey Street, Philadelphia, PA 19104 (215) 898-7874

UC DAVIS - UC Davis-VMTH, Building VMTH Room 1017, 1 Garrod Drive, Davis, CA 95616 (530) 752-7380

UKLDDC - University of Kentucky Disease Diagnostic Laboratory, 1429 Newtown Pike, Lexington, KY 40511 (859) 253-0571

UMINN - University of Minnesota, Veterinary Diagnostic Laboratory, 1333 Gortner Avenue, St. Paul, MN 55108 (612) 625-8787

VetGen - Veterinary Genetics Lab, UC Davis, One Shields Ave., Davis, CA 95616-8744 (530) 752-9780

LEGEND28

Documents

FORMULARY - Rood & Riddle Veterinary · PDF fileThe Rood and Riddle Equine Hospital Formulary of Medications in Usecontains medications and ... (loading dose), then Respiratory